A 69-year-old man presented with a 5-month history of painless, nonpruritic right-sided periorbital swelling. He was using no systemic or topical medications, and his medical history was noncontributory. In particular, he denied any history of facial flushing, photosensitivity, Raynaud syndrome, muscle weakness, thyroid disease, night sweats, and respiratory or bowel symptoms. Examination revealed nonpitting preseptal edema of the right upper eyelid, which was associated with erythema and induration of the right upper cheek area. The findings of ocular and orbital examination were unremarkable, with normal extraocular movements and no proptosis. Cranial nerve examination revealed subtle right-sided facial weakness (Figure 1). There were no abnormalities of the tongue or oral mucosa.